R.I.P. Ah Por

The last few weeks have not just been physically trying, but also mentally trying. The original plan to travel back home to Malaysia to attend a friend’s wedding cum mini IMU reunion, did not materialise as planned.

Within days of touching down in Malaysia, my beloved Grandma, of 88 years of age, had fallen gravely ill. After a couple of sleepless nights for everyone in the house, and a second visit to the Emergency Department, the true picture of her condition surfaced. She had suffered a heart attack, further complicated by a dense stroke and the finding of an aortic dissection. All of the diagnoses which, I have considered and explained to my parents, even before the diagnoses were revealed with further investigations. In a way, that could be considered as one of the best testament to my clinical acumen. After a few years in medicine, I have come to learn I have an astute sense of diagnoses, whether by luck or experience, my “sixth sense” had rarely been wrong. I had a feeling that she would not have long to live, despite some degree of improvement allowing her to be discharged home, that I had my younger brother flown back from UK to visit her. Sadly, I could not have been proven more right this time. She lasted a little under a week after she was discharged home.

She was 88 years old, although her IC had her at 85 due to under-reporting of age when she first came to Malaysia. She died peacefully in her sleep at home. There was no heroic yet often futile CPR or artificial life support. This might not have happened so smoothly if I have not been trained as a doctor or physician, for that, I am thankful.

I am sad. I miss her. I will miss her greatly for some times to come.

I have tried to distract my thoughts and rest my swollen eyes with more positive and academical stuff. Here are two of which really stroked my interests today.

A rather interesting thought, for I do not think I would be very comfortable with such transparency, not so much the commercial interests but more of my person.

Which got me thinking, what type of doctor I would describe myself as. Am I a good doctor? Do my patients like me?

All I can say, I think I am a rather competent doctor. I am a hospitalist, in the midst of being trained a physician i.e. the non-cutting types. I have broad knowledge and experience in multiple specialties, though I would not rank Neurology, Rheumatology and dermatology as my strong points. I like doing procedures and thus procedures  do not scare or faze me.

I am a rather strict doctor, with my practice of medicine more of a paternalistic type rather than the emphasis on patient’s autonomy in modern medicine. This is because, I think my job is more to treat patients to make them better, and if not, to relieve their suffering to the best of my abilities, not being a customer service relation officer. Throwing treatment options A,B,C or D at patients, with no recommendations or a personally justified stance as a doctor, or pandering to the certain insistence of some patients or family despite good and rational reasons not to, is not a proper use of our training and knowledge as doctors, in my opinion. I believe this is even more the case if the patient is in a grave condition or has an incurable disease. I relieve suffering but I do not treat people’s guilt.

Compared to my peers, I believed I have sat down a lot more often with many patients and family to discuss about diagnoses, treatments and even difficult decisions like end of life care. After striving initially in my career to try to “cure” as many patients as possible, I am now more amenable and definitely comfortable with the idea of palliative care and emphasis on comfort and quality of life than length. I am not a believer in alternative medicine, and would not actively recommend my patients to seek them.

I would normally use the older, proven and cheaper drugs on my patients rather than the newer and more expensive ones with marginal improvement in benefits. I believe this is essential for sustainable practice of medicine in a resources challenged era. If anyone wants a free advice, drink more water and exercise more. Definitely would work much better than those pills and I am saying this as a doctor. LOL.

I think that’s all for now. I need to rest my battered soul.

Arrivederci.